Ask the Experts:Controversies in Spine Procedures - Podcast 12

In episode 12, our experts covered your questions on:

• Which procedures benefit from conscious sedation?
• When should a comparative medial branch block (MBB) be used to select patients?
• Should a single MBB precede radiofrequency neurotomy (RFN) procedures?
• Should an anesthetic test dose be part of transforaminal epidural steroid injections (TFESIs)?
• Are we all on the same page when we use terms including ablation, coagulation, neurotomy, and rhizotomy?
• When considering imaging, is the contralateral oblique view superior to the lateral view for cervical interlaminar epidural steroid injections (ILESIs) or for thoracic or lumbosacral ILESIs?
• Is it helpful or necessary to obtain and review cervical MRI for TFESIs and ILESIs?

Your expert panel for this February 19, 2025 webinar included:

• Fred DeFrancesch, MD, of NeuroMuscular Medical Associates in Hammond, Metairie, and Baton Rouge, Louisiana, who also serves on the IPSIS Education Division, Guidelines Committee, and Instructor Development Committee; and
• Patrick H. Waring, MD, of the Pain Intervention Center in Metairie, Louisiana, who also serves on the IPSIS Education Division, Standards Division, and Guidelines Committee

The panel is moderated by Michael Furman, MD, MS, Fellowship Director at OSS Health, who serves on the IPSIS Board as a Member-at-Large, as well as on the IPSIS Education Division, and as Co-Chair of the Education Development Committee.

Episode 12 Show Notes: These are the abstracts referenced by our experts.

• Cohen SP et al. Consensus practice guidelines on interventions for lumbar facet joint pain from a multispecialty, international working group. Reg Anesth Pain Med 2020; 0: pp. 1-44.
• Gharibo C et al. Conus medullaris infarction after a right L4 transforaminal epidural steroid injection using dexamethasone. Pain Physician 2016; 19: E1211-E1214.
• Hurley RW et al. Consensus practice guidelines on interventions for cervical spine (facet) joint pain from a multispecialty international working group. Pain Med 2021; 22(11): pp. 2443-2523.
• Levi D et al. Safety of dexamethasone in transforaminal epidural steroid injections: A case of temporary paraplegia caused by injection of lidocaine and dexamethasone into a lumbar radiculomedullary artery, with no neurologic sequelae. Interventional Pain.
• Rathmell JP et al. Safeguards to prevent neurologic complications after epidural steroid injections. Anesthesiology 2015; 122: pp.974-84.
• Waring PH et al. Correcting the nomenclature of medial branch neurotomy to medial branch coagulation. Pain Med 2022; 23(3):603-4.

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